VIEWPOINTS
A Perspective on Nutrition Education Research and Practice
CHERYL ACHTERBERG,
Nutrition Department, The Pennsylvania State University, University Park, Pennsylvania 16802
The need for unification between nutrition education
research and practice has been the subject of consider-
able concern at both state and national levels (1). The
purpose of this article is to provide a viewpoint on how
this linking might occur.
At a philosophical level, nutrition education research
and practice are bound together because they exist to
affect the same end, i.e., "to further the probability that
human beings will take charge of their [nutritional] des-
tinies ... to provide human beings with liberating al-
ternatives" (2, p. 106). The nutrition educator is, as I
see it, a person who deliberately seeks to progressively
empower learners to act on food and nutrition-related
issues such that the learner is gradually freed from the
intervention and the materials. "Deliberately seeks" im-
plies a planned effort; "progressively" implies that effort
is a step-by-step process, each step building on the one
preceding it; "empower" means to enable people to act
in ways consistent with their knowledge and beliefs; and
to free a person from the intervention means that in the
end, we do not want the learner to rely on us or on our
learning tools for direction. How many of us, as nutri-
tionists, for example, daily check the number of personal
servings from the Four (or Five) Food Groups? Probably
none. Yet, we undoubtedly are competent to select a
balanced diet even without a food guide in hand. That
is also the position we ought to bring our learners to.
The nutrition education researcher is a person who
deliberately seeks out how best to perform that process,
i.e., how to effectively structure, package, and deliver
information to a particular audience in a particular setting
at a particular point in time (3). That process requires
more than dumping information, it requires that nutri-
tionists understand their learners' needs as learners. Such
understanding can be derived only through collaboration
between researchers and educators, but how can each
bring their oWn kind of knowledge to bear on a particular
problem?
The figure is a modification of Gowin's Vee heuristic
(4) that illustrates what the normative relationship be-
tween theory and practice should be. The left arm rep-
0022-3182/88/2005-0240$02.00/0
1988 SOCIETY FOR NUTRITION EDUCATION
240 JOURNAL OF NUTRITION EDUCATION
PH.D.
resents theory in research and the right arm represents
experience in practice. The two should be balanced such
that each informs the other on what to do next. And both
arms should come together at the point of a problem/
situation encountered in everyday life events or practice.
In actuality we commonly see three variations: discon-
nected theory, disconnected experience, and connected
theory-experience.
We are probably all familiar with disconnected theory.
It can happen when a theory is outdated or when a
scientist produces a theory that has no connection to
reality. So, it doesn't inform the practitioner how to cope
with reality. Lewin's gatekeeper (5) theory is an example
of disconnected theory in the 1980s. According to this
theory women control food choices in households. There-
fore, nutrition education should be targeted to female
homemakers. But common experience informs practi-
tioners that both men and children influence household
food-choice decisions. They may also select, purchase,
and prepare foods directly. Many households don't even
have women in them. Hence, Lewin's gatekeeper theory
is not an appropriate guide for practitioners in today's
setting (however useful it may have been in the 1940s)
because it is disconnected from our current, everyday
problems and realities.
In cases of disconnected experience, none of the les-
sons learned from observation or experience are for-
malized, so nothing about such experience can be shared
among people. This kind of practice is often driven by
intuition or what one of my colleagues calls "by the seat
of your pants." The problem with it is that it is not open
to scrutiny or reflection, so it goes nowhere. Whatever
knowledge exists is lost and the left arm of the Vee be-
comes stunted. The following example was drawn from
a highly successful dietetic practice. The particular prac-
titioner was able to classify Mexican-American women
into five types by their "look" and counseled them ac-
cording to type. The approach seemed to work fairly well
for her, but she was unable to articulate what she did so
neither she nor anyone else could improve upon it, teach
it to anyone else, or test it in another setting. When she
left, the approach literally disappeared. It was discon-
nected from the research arm and from reality because
it could not be replicated and, therefore, verified.
VOLUME 20 NUMBER 5 1988
 THEORY PRACTICE

QUESTION: What kind of

educational materials should
be developed to help
families with
hyperlipidemic children
lower their blood
lipid levels?
The most potent Heart-smart eating
setting in human patterns will be best
society is the family taught in a family
(Bronfenbrenner, 1979) setting
Children acquire most Home lessons should include
meanings through family involvement
interpersonal interaction
(Bronfenbrenner, 1979) Young children form many
meanings for food during the
People act towards things by early years
the meaning they give to those
things (Novak and Gowin, 1984)

REAL-LIFE

A home-based nutrition education

curricula designed for children
that involves family members. Its
purpose is to make heart-smart
choices meaningful to the child
in order to accomplish selected
dietary changes.
Figure. An example of connected theory-practice that converges on a real-life problem and educational event

The third option is to build a case for connected theory-
experience in order to increase the power of both re-
search and practice. The greater the number of links
between them, the stronger the structure and the more
powerful our educational efforts will be. Gowin (4) de-
scribed the nature of this linking or integration:
Thinking is not enough, nor is mindless acting.
Nor am I recommending the total indulgence
in feelings ihorn of thinking. Rather the flour-
ishing integration of thinking and feeling and
acting is the mark of an educated person (p.
46).
The thinking is represented by theory and research. The
feeling and acting comes from experience. They all must
be combined in order for all of us to become "educated
educators. "
One example is an educational program developed by
a university and a major research hospital. It was de-
signed for children diagnosed with genetic hyperlipi-
demia, i. e., all participants have serum lipids above the
90th percentile. On the research side two theories were
used, the ecology of human development (6) and the
theory of meaningful learning (7-9). According to these
theories families are the most potent settings in which
people learn new meanings; these meanings are acquired
primarily through interpersonal interaction, and mean-
ings are important because 1) they create our world(s)
and 2) people act towards things by the meanings they
give to those things. Meanings are understood in this
context to include both thinking and feeling. From the
practice side, it was felt that heart-smart eating patterns
could probably best be taught in a family setting (because
eating patterns are developed at home); that lessons

VOLUME 20 NUMBER 5 1988 JOURNAL OF NUTRITION EDUCATION 241

should include family involvement (because every family
member influences every other); and that young children
are "good" targets (because they are thought to learn a
great deal about food during their early years). The figure
is a visual depiction of how these research theories and
practice connect to each other.
This is, of course, an abbreviated version of the think-
ing that went into program development, but what came
out was a series of "talking books" featuring a gnome
cartoon character for the 4-7 year olds and a kid's club
for children aged 8-11 years old. Both Jerome the Gnome
and the Heart Smart Kid's Club create an atmosphere
of caring, to help children and families learn to deal
positively with their diagnosis as well as teach content.
Child activities and parent-child activities are included
with each lesson as well, and the whole family becomes
involved as the child plays and replays each audiotape.
The entire effort is the result of close collaboration be-
tween three nutrition education researchers, three clin-
ical dietitians, and two physicians. The program is cur-
rently in field testing, so the net results cannot be shared
at this time, but it is anticipated that this kind of an
integrated theory-practice approach will produce better
results than programs developed solely by practitioners
(without the input of researchers) or those developed
solely by researchers (without the input of practitioners).
The interdisciplinary team described above is probably
not within reach of many programs. What is important,
however, is not the number of people but rather the
number of links made between practice and research.
Even a single person with practical experience and a
research orientation can accomplish this integration. It's
feasible and it's necessary. But none of us can accomplish
this goal alone. Rather, we need a community of re-
searchers and practitioners who can share and combine
their thinking and experience to move this field forward
in a substantial and meaningful way.
Practitioners can do the following:
1) Raise questions and hypothesize answers. Research-
ers need practitioners to pose the questions that really
need to be answered in a practical setting. Practitioners
can also often identify likely or unlikely possibilities. But
researchers need practitioners to do more than that.
Practitioners should question the otherwise unques-
tioned answers in order to keep research honest. As
practitioners, you are people "in the know"; when an
"answer" doe's not connect with your world, you not only
have a right to question it, you have a responsibility.
You can start by raising questions and hypotheses among
your co-workers, employers, and fellow professionals in
your professional organizations.
2) Write. Write to individual researchers. Ask them
specific questions about why they do or do not do certain
things, or request help on certain problem issues. Most
242 JOURNAL OF NUTRITION EDUCATION
researchers would be delighted at the mere show of in-
terest in their work and extremely responsive to anyone
with a genuine interest. You can also write letters to the
editor of your professional journals and newsletters in
order to raise questions or pose possible solutions to
problems. The Journal of Nutrition Education also has
a section, GEMs (Great Educational Materials), reserved
in each issue for practitioners to share and describe the
various tools/techniques that they currently use.
3) Talk. Share special cases of success or dilemmas
with your own hospital or department group and also at
council, state, and national meetings. The Society ofNu-
trition Education has introduced conversation periods
featuring one or more individuals (practitioners or re-
searchers) who can meet and converse informally with
anyone interested in their work. This is a perfect op-
portunity for practitioners to learn from researchers what
they want to learn as well as for researchers to listen to
and learn from practitioners. Such conversation periods
can be introduced into other professional meetings as
well.
4) Read. A greal deal of pertinent work is already
published in nutrition education, but too little is read
by too few people.
5) 'join up." You can participate directly in the re-
search process. This can be done by contacting your local
university, a land-grant university, the Cooperative Ex-
tension Service or even the Dairy Council, American
Heart Association, or other community organization.
Many of these have programs to test (that might suit your
needs perfectly) or they may recognize your problem/
issue and work collaboratively to develop a study or pro-
gram that can address it appropriately. Alternatively, you
can perform small in-house studies on your own.
Researchers too can do much to contribute to an in-
tegrative approach. Argyris (2) identified three reasons
why research is not put into practice, including the com-
plexity of academic models, the problems with gener-
alizability associated with research studies, and the gen-
eral unfamiliarity of terms. I might add that a lack of
time to either read through, understand, or implement
a model may interfere with application as well. To ad-
dress these problems, researchers can do the following:
1) Listen. Take the time to listen to practitioners' needs
and concerns especially at professional meetings. You
may also set up a community advisory council composed
of a variety of practitioners who can, in a couple of meet-
ings a year, keep your finger on the pulse of their con-
cerns and contribute creative insights.
2) Talk. Try some of your ideas out on practitioners
before you initiate a research project. Their input could
refine your proposal and save you money, time, effort,
and heartache. Oftentimes their insight will make the
difference in whether a program is ultimately used or
not.
VOLUME 20 NUMBER 5 1988
 3) Write, but write in a language that is accessible to
the average practitioner. Dissatisfaction with research
jargon is probably the single biggest complaint that prac-
titioners level against researchers. Also, consider writing
reports for practitioners in their newsletters.
4) Involve practitioners. Seek them out. Develop at
least two or three relationships where you can feel free
to bounce ideas off each other. Whenever possible, build
practitioners into the actual research project. They will
help you keep your efforts honest.
5) Keep doing research, but include practitioners as
subjects too. They are an important audience, well worth
the time and study required to understand their needs
as learners too.
To conclude, everyone has something to contribute,
and together, we can make our everyday efforts more
effective. Nutrition education research that does not help
practitioners take action in real situations is, in the end,
meaningless. Contrariwise, a practice that is devoid of
any theory or research base is destined (doomed) to make
the same mistakes over and over. But taken together,
the faults of each are more easily corrected, and united,
researchers and practitioners can make a real difference
in the world. 0
LITERATURE CITED
1 Lewis, M., ed. Proceedings from the leading edge in nutrition ed-
ucation: Research enhancing practice. Journal of The American Die-
tetic Association 87: 51-582, 1987.
2 Argyris, C. Making knowledge more relevant to practice: Maps for
action. In Doing research that is useful to theory and practice . E . E .
Lawler, A.M. Mohrman, Jr. , S.A. Mohrman, et al., eds. San Fran-
cisco: Jossey-Bass, 1985, pp. 79-125.
3 Sims, L. Nutrition education research: Reaching toward the leading
edge. Journal of The American Dietetic Association 87:S10-518,
1987.
4 Gowin, D.B. Educating . Ithaca, NY: Cornell University Press, 1981,
pp. 9-21O.
5 Lewin, K. Forces behind food habits and methods of change. In The
problem of changing food habits. National Academy of Sciences
Bulletin no. 108. Washington, DC, 1943, pp. 35-65.
6 Bronfenbrenner, U. The ecology of human development . Cam-
bridge, MA: Harvard University Press, 1979, pp. 3-330.
7 Novak, J.D., and D.B. Gowin. Learning how to learn . Cambridge,
MA: Cambridge University Press, 1984, pp. 1-199.
8 Novak, J.D. A theory of education. Ithaca, NY: Cornell University
Press, 1977, pp. 5-295.
9 Ausubel, D.P. , J.D. Novak, and H . Hanesian. Educational psy-
chology, A cognitive view , 2d ed. New York: Holt, Rinehart, and
Winston, 1978, pp. 3-733.

PHYSICIANS' AND PATIENTS' VIEWS OF PROBLEMS

OF COMPLIANCE WITH DIABETES REGIMENS

The high prevalence of noncompliance among patients with diabetes provided the impetus
for a study that examined and compared patients' and physicians' "perceptions of the difficulty
of various aspects of the diabetic treatment regimen" (Pendleton et al. Pu.blic Health Reports
102[1]:21-26, 1987). Researchers surveyed 30 medical residents and 30 patients with nonin-
sulin-dependent diabetes (average 62 years of age) from the same hospital. Using a lO-point
scale, both groups rated the difficulty of complying with nine tasks falling under three major
treatment areas: medication, diet, and urine testing. Higher scores indicated greater difficulty.
Analysis of variance was used to examine the responses of the two groups, the specific task
difficulty ratings within each treatment area, and statistical interactions between groups and
tasks.
In each treatment area, doctors rated the tasks as being more difficult than did the patients.
Both groups rated diet-related tasks as most difficult and medication-related tasks as least
difficult. Within each area, the difficulty rating of the three specific tasks varied, and the
variation was greater among patients than physicians. Dietary tasks included "avoiding pro-
hibited foods," "not exceeding recommended amount," and "adhering to schedule." The
, difficulty ratings patients gave these tasks were 6.9, 5.4, and 3.4, respectively, while physicians
rated them 7.3, 7.5, and 6.5, respectively.
Given the level of noncompliance among diabetic patients, the authors considered the
patient ratings for difficulty of compliance as "suspiciously low"; most were in the range
between "moderately difficult" and "not difficult." They speculated that patients may have
been concerned about confidentiality or may have been denying compliance difficulties as
part of a general denial of the illness. However, for nutrition practitioners the differentiation
of task difficulty exhibited by patients proVides potentially useful insights. In counseling
diabetics, we should probably place greater emphasis on those tasks-such as avoiding pro-
hibited foods-that patients view as most difficult. (This article contains 19 references.)

VOLUME 20 NUMBER 5 1988 JOURNAL OF NUTRITION EDUCATION 243